The overall goal of this multi-phase SBIR research effort is to develop a handheld fall risk assessment instrument for use by health and elder care providers. Falls occur in up to 30% of those over the age of 65 and up to 40% for people over the age of 80. Falls place each individual at risk for dangerous closed head injury and long bone fractures. The mortality rate at one year following a hip fracture has been reported to be as high as 27%, with another 22% losing the ability to ambulate. The new instrument will ensure that individuals at increased risk for falling are identified and provided with appropriate interventions to reduce fall occurrences. Avoidance of injurious falls will result in reduced pain and suffering and will lower costs of patient care, the bulk of which are borne by Medicare. Bayesian belief networks are the key technology that will enable faster and more accurate fall assessments;the Bayesian methodology allows the merging of disparate information into a unified and objective stochastic assessment of fall risk. The fall risk assessment tool will furnish a universal algorithm for initializing, adapting, and optimizing fall risk assessments based on the patient risk factor data that are available in a given setting. The proposed approach will leverage two important and extant assets: (1) an extensive literature on fall risk factors and fall prevalence statistics;and (2) institution-specific patient fall risk factor and fall outcomes data (these data can be used to train and adapt the new assessment tool, allowing accurate, clinically relevant estimates to be obtained for particular settings). These two data assets will be used effectively to close the loop between evidence and practice. PUBLIC HEALTH RELEVANCE: The proposed tool will provide superior identification of patients at risk for falling than presently-available screening instruments and will lead to changes in clinical practice that affect patient care through more accurate targeting of fall risk prevention interventions. The new tool will find a ready market as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began requiring (effective 2005) health care organizations seeking accreditation to routinely assess and periodically reassess each patient's risk for falling and to take action to reduce the risk of falling.